401k Plan data: WOMEN FIRST HEALTH CARE RETIREMENT PLAN plan

WOMEN FIRST HEALTH CARE RETIREMENT PLAN 401k Plan overview

Plan Name	WOMEN FIRST HEALTH CARE RETIREMENT PLAN
Plan identification number	001

WOMEN FIRST HEALTH CARE RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

WOMEN FIRST HEALTH CARE OF WNY, P.C. has sponsored the creation of one or more 401k plans.

Company Name: WOMEN FIRST HEALTH CARE OF WNY, P.C.

Employer identification number (EIN): 943414339

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WOMEN FIRST HEALTH CARE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 GIL FARKASH 2015-11-11 GIL FARKASH 2015-11-11
001 2014-01-01 GIL FARKASH 2015-07-23 GIL FARKASH 2015-07-23
001 2013-01-01 GIL FARKASH 2014-07-24 GIL FARKASH 2014-07-24
001 2012-01-01 GIL FARKASH 2013-07-18 GIL FARKASH 2013-07-18
001 2011-01-01 GIL FARKASH GIL FARKASH 2012-06-27
001 2009-01-01 GIL FARKASH GIL FARKASH 2010-07-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	GIL FARKASH	2015-11-11	GIL FARKASH	2015-11-11
001	2014-01-01	GIL FARKASH	2015-07-23	GIL FARKASH	2015-07-23
001	2013-01-01	GIL FARKASH	2014-07-24	GIL FARKASH	2014-07-24
001	2012-01-01	GIL FARKASH	2013-07-18	GIL FARKASH	2013-07-18
001	2011-01-01	GIL FARKASH		GIL FARKASH	2012-06-27
001	2009-01-01	GIL FARKASH		GIL FARKASH	2010-07-08

Plan Statistics for WOMEN FIRST HEALTH CARE RETIREMENT PLAN

401k plan membership statisitcs for WOMEN FIRST HEALTH CARE RETIREMENT PLAN

Measure Date Value
2011: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 13
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 14
Number of participants with account balances 2011-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 11
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 12
Number of participants with account balances 2009-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	13
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	14
Number of participants with account balances	2011-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	11
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	12
Number of participants with account balances	2009-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on WOMEN FIRST HEALTH CARE RETIREMENT PLAN

Measure	Date	Value
2011 : WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$44,139
Expenses. Total of all expenses incurred	2011-12-31	$6,693
Total plan assets at end of year	2011-12-31	$450,630
Total plan assets at beginning of year	2011-12-31	$413,184
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$47,195
Other income received	2011-12-31	$-18,925
Net income (gross income less expenses)	2011-12-31	$37,446
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$450,630
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$413,184
Assets. Value of participant loans	2011-12-31	$7,401
Total contributions received or receivable from employer(s)	2011-12-31	$15,869
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$6,693
2010 : WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$115,843
Expenses. Total of all expenses incurred	2010-12-31	$5,954
Benefits paid (including direct rollovers)	2010-12-31	$517
Total plan assets at end of year	2010-12-31	$413,184
Total plan assets at beginning of year	2010-12-31	$303,295
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$47,293
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$51,201
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$109,889
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$413,184
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$303,295
Assets. Value of participant loans	2010-12-31	$10,978
Total contributions received or receivable from employer(s)	2010-12-31	$17,349
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$5,437
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for WOMEN FIRST HEALTH CARE RETIREMENT PLAN

2011: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: WOMEN FIRST HEALTH CARE RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80655

Policy instance

Insurance contract or identification number	80655
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,916
Total amount of fees paid to insurance company	USD $216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80655

Policy instance

Insurance contract or identification number	80655
Number of Individuals Covered	13
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,044
Total amount of fees paid to insurance company	USD $279
Commission paid to Insurance Broker	USD $3,044
Insurance broker organization code?	3
Amount paid for insurance broker fees	279
Additional information about fees paid to insurance broker	TPA FEES & COMPENSATION
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC.

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Company Name:	WOMEN FIRST HEALTH CARE OF WNY, P.C.
Employer identification number (EIN):	943414339
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)